Amhet1

Being a fan of Monty Python, I feel the need to add these gems..... I fart in your general direction! Your mother was a hampster, and your father smelt of Elderberries! What is the airspeed velocity of an unladen swallow? Is that an African or a European swallow? "But I'm not dead yet","Yes you are!" "I Got Better." And a favorite Cartman line..... "Ive been licking this carpet for three hours and I still dont feel like a lesbian!" and (paraphrasing) "My grandfather was german and my grandmother was lesbian, so that makes me a quarter lesbian!"

You can probably bet that guy wont get caught with his pants down again. sorry, had to say it.

"First, Asys said in his post that he took the rest of the day off. Second, if you are receiving a stipend then you are not doing it for "no pay" and are not volunteering (use whatever word you want but you are getting paid). " True, took the rest of the day AFTER he became grossly symptomatic. What if that occurred while treating a patient? Or transporting the patient to the hospital? Instead of just risking himself, he has to risk himself, his partner, his patient, and everyone on the streets. Second, and more importantly, if you want to equate money in whatever form to volunteerism, then we must not have near as many volunteer services as I thought. When I started in this business 30 years ago, our small service provided a stipend of $5.00 a call (A call being a patient transported to a hospital, NOT for standby's, being on call, community activities, meetings, training). With that, we had to pay for our EMT class, CEUs, uniforms, laundry, gas, refreshers, etc. You didnt "volunteer" for the money, you volunteered to help others. I didnt realize that by todays definition, that was a "paid" position.

"But I think my dedication trumps any vollie any day of the week." Really? You do this for no pay, hours away from freinds and family for education, training, runs, and spend more out of pocket than you make in any stipend you might get for taking the calls? If you had true dedication, you would have taken yourself out of service.... a dead medic saves nobody.

pro·fes·sion·al Audio Help /prəˈfɛʃənl/ Pronunciation Key - Show Spelled Pronunciation[pruh-fesh-uh-nl] Pronunciation Key - Show IPA Pronunciation –adjective 1. following an occupation as a means of livelihood or for gain: a professional builder. 2. of, pertaining to, or connected with a profession: professional studies. 3. appropriate to a profession: professional objectivity. 4. engaged in one of the learned professions: A lawyer is a professional person. 5. following as a business an occupation ordinarily engaged in as a pastime: a professional golfer. 6. making a business or constant practice of something not properly to be regarded as a business: “A salesman,” he said, “is a professional optimist.” 7. undertaken or engaged in as a means of livelihood or for gain: professional baseball. 8. of or for a professional person or his or her place of business or work: a professional apartment; professional equipment. 9. done by a professional; expert: professional car repairs. –noun 10. a person who belongs to one of the professions, esp. one of the learned professions. 11. a person who earns a living in a sport or other occupation frequently engaged in by amateurs: a golf professional. 12. an expert player, as of golf or tennis, serving as a teacher, consultant, performer, or contestant; pro. 13. a person who is expert at his or her work: You can tell by her comments that this editor is a real professional. vol·un·teer Audio Help (vŏl'ən-tîr') Pronunciation Key n. A person who performs or offers to perform a service voluntarily: an information booth staffed by volunteers; hospital volunteers. Law A person who renders aid, performs a service, or assumes an obligation voluntarily. A person who holds property under a deed made without consideration. Botany A cultivated plant growing from self-sown or accidentally dropped seed. adj. Being, consisting of, or done by volunteers: volunteer firefighters; volunteer tutoring. Botany Growing from self-sown or accidentally dropped seed. Used of a cultivated plant or crop. pas·sion Audio Help /ˈpæʃən/ Pronunciation Key - Show Spelled Pronunciation[pash-uhn] Pronunciation Key - Show IPA Pronunciation –noun 1. any powerful or compelling emotion or feeling, as love or hate. 2. strong amorous feeling or desire; love; ardor. 3. strong sexual desire; lust. 4. an instance or experience of strong love or sexual desire. 5. a person toward whom one feels strong love or sexual desire. 6. a strong or extravagant fondness, enthusiasm, or desire for anything: a passion for music. 7. the object of such a fondness or desire: Accuracy became a passion with him. 8. an outburst of strong emotion or feeling: He suddenly broke into a passion of bitter words. 9. violent anger. 10. the state of being acted upon or affected by something external, esp. something alien to one's nature or one's customary behavior (contrasted with action). 11. (often initial capital letter) Theology. a. the sufferings of Christ on the cross or His sufferings subsequent to the Last Supper. b. the narrative of Christ's sufferings as recorded in the Gospels. 12. Archaic. the sufferings of a martyr. Is a volunteer fireman any less of a fireman than one that does it full time? Does fire training differ between a volunteer and a professional fireman? Does our training differ between volunteer EMS and full-time? We have a fixed set of training requirements. We have standards that we have to maintain in CEUs, refreshers, training, and specific skill sets. I have spent time as a volunteer and full-time. I have seen the differences. The differences are many, but the bottom line comes down to experience. Someone with 200 runs has a different mindset than someone with 2000 or 20,000. Full-timers take a paid position in their town because it fits their lifestyle, the pay meets their needs, and hopefully doing what they enjoy doing. Volunteers live in BFE and have an interest in helping their family, freinds and community. They also may be looking at career opportunities. They voluntarily go thru the same training, meet the same standards, go thru the same things that full-time do, and do it often on their own dime and time. The term "passion" is the overriding factor in the discussion. When a volunteer loses the passion for EMS, they can just walk away. A full-time person may not have the chance to "just walk away" per se. The full-time person has the risk of burn out where a volunteer has little risk of it. Personally, when someone loses interest and stops learning, they are no longer an asset and may want to look for a new profession. If I still lived in BFE, would I still have the "passion" to continue to volunteer after 30 years? Probably not. Do i still want to spend hours in the back of an ambulance or sucking deisel exhaust... Not if I can avoid it. I have found that I enjoy quality analysis and process improvement. I enjoyed my time as a volunteer and loved the people I worked with. I cant say that about the staffs of some of the full-time services Ive rode with. It may have been the folks I worked with. The question of who has more passion is truely mute. For those with strong opinions either way needs to walk in the others boots. I want to send a challenge. If you're full-time, "adopt" a volunteer service and share your experience and knowledge. Help them to become the medics you think they should be. Volunteers, go find a FT service and get some ride time with them. See what other services do and how they do things. Pick the medics brain for tips and tricks.

Or a denture cup..... but then again... um, nevermind. :shock:

"I wonder if it was a large coverage area this guy worked.. Rural versus Urban. " AMR Denver was the first division.... downtown Denver..... Longmont is about an hour N of Denver... probably quite a bit slower than Denver, im sure. Just to make things more painful, AMRs Corporate Headquarters is in a suburb of Denver :shock:

Angel, I didnt read all the posts, but I have a couple of points to make... whether they have been made previously, or not. 1) the only time a patient isnt taken to the hospital of their choice is if the injury dictates a specialty, ie, burn unit, trauma center, CT availablility, etc. If a patient is NOT taken to the facility of their choice without an overriding factor, it "can" be considered kidnapping. Kidnapping and unlawful confinement have been used as arguments against EMS. The other issue is "diversion". If a patient requests a specific hospital, failure to transport them there can be an EMTALA violation. There is a growing concensus in the legal opinions that just making radio contact with the hospital puts EMTALA in force. As much as the hospitals may not like it, "diversion" is really becoming a thing of the past. 2) Law enforcement has NO authority over the patient destination UNLESS the patient is in custody. As an EMT in a previous life working on a state line, I am well aware that LEO's can cross state lines to enforce laws occuring in their jurisdiction. In what you describe (minus the personal comments), the LEO was going to be "inconvenienced" in having to drive another 3 minutes to the hospital WV. Im sure he had additional paperwork because of it, but it did not interfere with his duties. I was going to make a third point, but I forgot what it was.. oops. Oh, 3) Working for a bad service is worse than working for no service. Someone mentioned bad habits you may pick up and I agree for a different reason. They were concerned that you would develop bad habits with your basic skills that could effect going thru P school. I disagree with that thought, but I digress. If you start questioning yourself now, you may question yourself you have to make an important call. I agree with the other in that you need to find a P school and get into school as soon as possible. The other thing you may want to do is get out of the situation you're in. Find a better service, go work in an ER or somewhere you can still maintain your skills and knowledge. I would also recommend taking a few notes and if you see a number of violations of KY code, consider contacting the state with those violations. They have to be pointed and specific. You cannot go to the state with wishy-washy, non-specific innuendo or rumor. They probably wouldnt act on that. Good luck and keep us informed!

Jack, thanks for the comments of the new and improved Danver Paramedics. My concern tho, is that it has been 4 years and problems are coming to light, or never changed. My other concern is the language you've used to state your defense of DH..... Paramedics at DG were FORCED to: Double load patients from 2 different calls Never FORCED to do so. In some cases it has been allowed to happen The standard of care is to provide 1 run, 1 delivery to an ER. How, at ANY time, can you justify going from one call to another with a patient already loaded. It makes sense for a taxi to do so to save time and costs, but an ambulance is NOT a taxi. Administer sublingual Narcan and walk away from Overdose patients Never forced, nor allowed to happen. Lie! ColoadoEMS was there during the Gravitz administration. He may have seen it first-hand, so if you can prove that it has NEVER happened, how could it be a lie? Drive like a madman to make unrealistic response times Never forced anyone to drive a certain style, for any reason. This one is a bit more obvious, but lets review a few facts first. 22 ambulances, 150 sq miles. That equates to 6.81 sq miles to cover by each unit IF fully staffed and available. Now being generous, if DH has an average UHU of .65, 14.3 units are busy at any one time, that leaves 7.7 units available to cover 150 sq miles or an average of 19.48 sq miles each. If the unit is located in the center of that 19.48 sw miles, it will take AT LEAST 10.55 minutes.....So, there is a good chance that unit from Downtown could be sent to DIA. How do they get there in "8:59" without driving like a bat out of hell? Im sure your staff is not "forced" to drive in any certain style, but when a contract says you WILL be on scene within a specific time period and you only have a certain number of units, something has to give, and the easiest is safety through poor driving techniques. Dump patients at the ED without proper handoff reports "proper" as defined by whom? FORCED, NOT! OK, back to Basic school.... a "proper" report is a face-to-face verbal report of patient status, care and treatment, and situation surrounding the illness or injury. This is typically followed by a complete and accurate written report. For the more important part of the statement tho... Your crews have never got the patient out of the back of the unit and getting toned for your next call? Do you have the pleasure of a detailed verbal report, cup of coffee while completing the written report, clean the unit, remake the gurney, then advise dispatch you're available to respond to the next call? Typically not. You get them in, on the ER bed, quick verbal, and back out the door. Short answer is Too many calls and not enough units = FORCED to dump pts quickly! Handle ALL the EMS calls with 7,8,9 buses on in the city There haven't been this few buses on the schedule for almost 10 years! I have run your numbers. There is no way mathmatically or any other way that you can provide the proper level of coverage even if you have all 22 units on the road 24/7. 20 years ago, 20 units running double paramedics worked fine, but that was 50 sq miles and a few hundred thousand peopel fewer. Refuse care and transport to patients due to overload No one has ever been denied care or transport for this reason, let alone forcing employees to behave in this manner. This comes back to my previous statements. Basic school taught us that things like negligence and abandonment are bad. With 22 units, you WILL be overloaded at least 75% of the time. Personally, I am even against encouraging a pateint to refuse, unless you can justify it in court. Obviously, there is only so much that can be done to improve things at DH. Until there are fundemental changes in the system, your crews will continue to run their [s:34ad5a2e98]asses[/s:34ad5a2e98] butts off, have unacceptable response times (when tracked CORRECTLY), and being on a sinking ship. For AT LEAST the last four years if not significantly longer, your crews have bailing water from the ship but its becoming obvious that they cant keep up. Do I REALLY need to say anything about how that MIGHT effect morale? It is unfortunate that Mr Nugent has allowed the system to fail. It has failed his crews, DH, and the people of the city and county of Denver. I really wonder if anyone has actually explained things like quality improvement, or processes, or how to even how to look at the numbers and figure out, surprisingly, that he doesnt have enough GD AMBULANCES? It is PAINFULLY obvious that the system is broken and perfume wont make the pig smell better. You have enough mutual aid that there should NEVER be a 25 minute wait for an ambulance to come available. Jack, I love your passion and support of DH, and I understand that your comments are from your heart. The recommendation of the Council President to send in an independent consultant is not a bad idea. The hardest thing to do sometimes is to see the problems from the inside. I would love to talk with you more about this. It would be great to discuss your numbers and see if my numbers are in the ballpark. PS: Sorry about all the cliches :roll:

CBEMT found this article on Denvers Response time problems.... makes for interesting reading http://www.westword.com/2008-06-05/news/de...rgency-response

CBEMT posted this article in another forum and fits well here too.... http://www.westword.com/2008-06-05/news/de...rgency-response It covers a few aspects of the problems.... response time issues.... lack of available units... personnel morale..... inadequate management.....

There is a serious problem when they have 20 ambulances on the road ant any one time and cant respond to all the of the requests. There are at least 3 other services operating in and around Denver County. A logical thought is that Denver could farm out the lower priority calls to the privates and use their ambulances for the "delta's" and "echo's". Im sure the privates wouldnt have a problem with that. DH is a non-profit, tax supported Hospital so they have no incentive to make any changes or improvements. They are also not afraid to run their staff into the ground and burn them out in very few years. There are enough young, testosterone-filled P school grads available to keep most of their vehicles on the road. Just to add one more reason for DH's poor performance is the fact that Denver Comm is about 20+ FTEs short.... so they're trying hard to burn out the comm staff too.

Thanks for the article, n0ssb! I copied part of it to my response times poll (with credit to you, of course) Its sad really... DH Paramedics sounds like a typical FD run EMS.... If it were to go to Denver FD..... well, I guess it cant get much worse.... I guess it would be best to rebuild them as a separate and distinct 3rd service but it would require the EMS side to strip down and completely rebuild to completely change the mindset and image of the service. Your "typical" hospital based EMS functions well because it has the support of the administration and enough subject matter experts to turn to. That doesnt ensure success as in the case of DH. THough I havent looked too hard, but I havent seen anything derogatory about Wishard in Indy. The other option is to rebuild the entire system as a PUM. Unfortunately, a PUM is the most expensive way to operate an Emergency Response System. The positive aspect is that the contractor has to meet strict standards and either lose money thru fines or risk losing the contract completely. AMR, Pridemark, ActionCare are all positioned to step up. The system has to be designed to minimize the current issues being seen in Tampa. The FDs are now sending multiple units on medicals. This is an issue that the the Emergency Manager for Pinellas Co has to deal with. There are also FDs that are pushing for their own EMS and leave the indigents to SunStar (as is the case with WestMetro dumping their boring, BLS, or indigent transports on ActionCare). As you may notice, Im not a big fan of FD provided EMS. Most FD/EMS programs are stark and dismal failures. Many agree that EMS and Fire are very different creatures. The biggest problem is that EMS often falls under operations and there is little support from above. For EMS to work within a FD structure, EMS has to be a separate division that answers only to the Chief of the department, and even then, if the Chief doesnt have experience in EMS administration, there may still be little support.

This is from an article on Denver Paramedics and the Hospital System..... (Thanks to n0ssb for posting this in the delayed response forum) "The contract states that paramedic response times are measured from "when the EMS dispatcher receives the call from the call-taker or from the Police or Fire Department" to "when the ambulance arrives on the scene." Petre said that in 2004, the hospital started calculating paramedic response from the time an ambulance is assigned. He said the shift dramatically undercounts the actual response time because all of Denver Health's ambulances are regularly in use. That means dispatchers must wait for one to come free before it can be sent to the next call. Significant delays result, Petre said, and those aren't reflected in the way Denver Health has been calculating response times. "They routinely run out of ambulances," Petre said. Denver's Health's new way of calculating response times was first reported this week by Westword. KMGH-TV, Channel 7, has also reported extensively on Denver Health's ambulance service. Impact on compliance The way ambulance response times are calculated affects the hospital's compliance with performance standards specified in the city contract. The contract with Denver requires the hospital to get an ambulance to an emergency within 8 minutes and 58 seconds, 85 percent of the time. The hospital reports that is exactly the current response rate. " My guess is there was 2 changes... They changed when the clock starts from when the call is passed to the dispatcher to a point where the dispatcher can assign an ambulance thus "improving" their response times by probably 2 minutes. What the story doesnt say is that they probably the end time as arrival "on-scene"..... which would eliminate any sort of vertical response time. My guess is that they used to have the end time as "at patient". As much as I know of downtown Denver, there are plenty of buildings that could have 5-10 minute times just getting from the front door to the correct floor. From the street level medic, times are really only a few boxes on a form, but as you can see from the article those times can have far more impact on your service. Denver Paramedics response times are starting to look like the tip of an iceberg of far deeper problems....

If you want to look for a zebra, check for dependent edema..... depending on where he was at the time, i.e. recliner, there could be a fluid overload problem..... he does have varicose veins which means he already probably has fluid issues. chbare is thinking along the same lines.... JVD and listening for bruits could be meaningful. Checking glucose is always appropriate in a syncope pt. The other option is Kaisu's theory..... circulation was transferred from one head to the other..... got a boner and passed out.

Does that script come with an extra 5mg valium for the nurse? Hey doc, how close were my WAGs on the valium and benadryl?

LOL!!![/font:fca6390ce0] Would you prefer Epi or a lead injection?

I left the title sort of ambiguous for a couple reasons... 1) I dont know what Im doing yet and 2) to see some thoughts and opinions without getting too specific. I would like to play devils advocate for a sec here.... Jake mentioned that their services clock starts when they get toned out...... what happens when you arrive on scene and the family is irrate because it took ya 25 minutes to get there? Your records say that it only took 7 minutes from tone-out to arrival..... Props due to SF FD for that true situation.... And dont worry, there are no "errors" here, just some fact and opinion

Anthony makes an interesting point in that rural EMS is significantly different in many respects. When I first started in this business, i ran with a small volunteer service that ran 2-3 calls a week. It wasnt cost-effective for anything but a volunteer service. Our situation was similar to Anthony's in that we would respond when we got called. Looking back, our system was AFU.... but it was all pre-911.... the most advanced peice of equipment we had was a HERN/HEAR radio to contact the hospitals..... Our nearest hospital was 30 minutes away running hot. Being pre-911, we had a 7-digit line answered by local PD. Once they got the information, they had to call each crewmember individually, and it could take anywhere from 5-15 minutes for the crew to get there.... Luckily, if one person was between the call and the shed, the ambulance could meet the other staff member enroute. But back to the benchamrking discussion, that raises another issue.... To benchmark EMS, we also need to define the service in some way. My personal thought on it is to stratify the data based on population density of the coverage area. To simplify, base the population density on the county the service is in or the county they have the greater coverage area (if they cover parts of more than one county). This is the most logical idea I can come up with because that is the most common denominator I can come up with. It would be illogical to benchmark a large urban service serving 500,000 people over 35 sq miles to a volunteer service covering 1,500 people over 3,000 sq miles.....

Dust mentioned "A tonne of New York companies, including American Airlines, moved here in the last few decades, so there are a crapload (read: too many) of frostbacks down here already." Are frostbacks anything like our "Florida Bluehairs"? I have read the reports about Galveston and how AFU Houston is. Instead of a standard ambulance staff, Houston has 65 ambulances, with 12 BLS, 10 all ALS (in the more rural areas, and the rest are 1/1. That alone is a recipe for disaster. Over half of the units are running 5,000 runs or more. More than a dozen units are averaging >1.00 UHU per shift. To put that into perspective, a unit running more than 3,000 calls per year is being overtasked. UHU's should be .35 (static deployment) to .65 (dynamic deployment). But to get back on topic (sorta).... Wasnt it Houston or Dallas that did the study that essentially killed MAST trousers?? I remember it, but too old to remember the specifics surrounding it. Im pretty sure that it was in urban Texas where the transport times were <10 minutes and the patients that died were going to anyway so they blamed the MAST....

Maybe thats the french spelling, Richard

I know I have no problems with vertigo when I take valium..... I may fall down, but I dont care. But on a more serious note, my guess (and it really is just a WAG), is that it may calm things in the inner ear releiving some of the vertigo. Or maybe they're so relaxed that they dont care they're dizzy. As far as the Benadryl question, I was about to pull a reason outa my butt and check my references but they're packed up for the move. I did find this online tho.... from wikipedia: "Diphenhydramine (dye fen hye' dra meen) works by blocking the effect of histamine at H1 receptor sites. This results in effects such as the reduction of smooth muscle contraction, making diphenhydramine a popular choice for treatment of the symptoms of allergic rhinitis, hives, motion sickness, and insect bites and stings." Since the stomach and intestines are smooth muscle, it makes sense that by calming a spasming stomach, there would be a decrease in emesis. Its just another WAG, but it makes sense to me.

These people that contract with associations to rasie funds for charity are frquently in the news for their operations. Everyone from "60 Minutes" to OReilly have hadreports of these scumbags. There was a story recently of a guy in VA/DC area that was raising money for Disabled Iraq Veterans or something like that and had raised something like $8,000,000. He had 3 HUGE homes (to rival Al Gores), exotic cars and a personal jet (oops, his "business" jet), etc. Records indicated he gave $100,000 to the DAV. Other professional "Fund Raising" businesses frequently report costs in excess of 96%, but many are also filed as "non-profit" to dodge the taxes......

With very little work, a person can find that departments start their "response time" clock at various times. Many use the shortest time to make the numbers look good. The true "response time" is from the time the emergency is known to exist to arrival of YOUR service. From the patients' point of view, we know that 10 minutes can feel like 20-30 minutes or more. If we are here for the patient, shouldnt the clock start when the patient/callers clock starts? The caller finds the patient, panics, regains control, helps the patient, calls 911, give information, answers questions, hangs up, panics some more, then finally relaxs when the crew walks in the door. 1) We typically hear of call-takers spending 1-3 minutes to get patient information, situation and address. (3 minutes) 2) Another 1-2 minutes for the dispatcher to assign the call (5 minutes) 3) 1-2 minutes for the vehicle to get enroute (7 minutes) 4) and travel time to the scene (8:59) (9 to 16 minutes or more) I know that is sounds rather far-fetched for an urban system to have 10-20 minutes to make patient contact, but those are also some documented times for some departments. The underlying problem is benchmarking. When you compare your times to another service the definition of "response time" needs to be uniform so as to compare apples to apples. In this situation, EMS remains in a "pre-NEMSIS/pre-NFIRS". At some point, NHTSA will fund a project to create those definitions. Again, EMS remains behind the power curve in that LE and Fire have the necessary peices and support to compare those apples to apples. There is no question that EMS does the right thing 99.9% of the time. We just have a problem in proving it. What is your opinion on when the clock should start? Do you, on your PCR, record any times prior to going enroute? Does your software/dispatcher track any times prior to dispatch?

You would think I like the taste of shoe leather with the amount of time I sit here with my foot in my mouth. :shrugs: